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INTERNATIONAL JOURNAL OF MAXILLOFACIAL RESEARCH VOLUME 1 ISSUE 2 2015

75

Reattachment of Coronal Tooth Fragment:

A Case Report

Rastogi R1 , Goyal A2 , Rajkumar B 3

Trauma to the permanent teeth is a common event among children and adolescents. Crown

fracture present almost 92% of all traumatic injuries of the permanent teeth. The anterior

incisors are most often affected because the anterior position of the maxilla and tooth

protrusion. One of the options for managing coronal tooth fractures when the tooth fragment

is available is the reattachment of the fractured fragment. Reconstruction of crown fractures

has developed through the years. Elaboration in the field of adhesive dentistry has given

opportunity to the clinicians to have minimal invasive approach and achieve esthetic and

functional restoration of the fractured tooth.

Keywords: Anterior crown fracture, Dual Cure Resin, Fiber Post, Reattachment.

INTRODUCTION

Facial trauma that results in

fractured, displaced, or lost teeth can have

significant negative functional, esthetic,

and psychological effects1. The most

common injuries to permanent teeth occur

secondary to falls, followed by traffic

accidents, violence, and sports2. Several

factors have to be taken into consideration

in the management of coronal tooth

fractures. These include extent of fracture,

biological width violation, endodontic

involvement, alveolar bone fracture,

pattern of fracture and restorability of

fractured tooth, presence/absence of

fractured tooth fragment and its condition

for use like occlusion and esthetics3. One

of the options for managing coronal tooth

fractures is reattachment of tooth fragment

when it is available and the fragment is

intact with good adaptation to the

remaining tooth. Reattachment of the tooth

fragment provides a conservative,

esthetic, and cost- effective restorative

option that has been shown to be an

acceptable alternative to the restoration of

the fractured tooth with resin-based

composite or full-coverage crown.

Reattachment of a fragment to the

fractured tooth can provide good and long-

lasting esthetics (because the tooth’s

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original anatomic form, color, and surface

texture are maintained). The successful

reattachment depends on fragment’s

extend of dehydration. The longer the

fragment remains dehydrated the poor

tooth’s strength will be. Improvement of

tooth’s resistance can be achieved by

fragment rehydration4.

CASE REPORT

A 35 years old male patient reported to the

Department of Conservative Dentistry and

Endodontics, Babu Banarasi Das College of

Dental Sciences, Lucknow, India following

trauma to maxillary right and left central

incisor due to fall on ground. On intraoral

examination Ellis Class III fracture was seen

with crown portion of 11and 21, which

extended from cervical 3rd of crown on labial

side to cement enamel junction on the lingual

aspect.

Figure 1. Preoperative View

Figure 2. Fractured segment Removed

The fracture fragment was removed

atraumatically and stored in normal saline.

Single visit root canal treatment with sectional

obturation was done. Post space preparation

was done with peso reamers. Trough was

prepared in the fractured crown fragment then

the fracture crown fragment was reattached

with remaining tooth portion by suitable fiber

post (FRC Postec Plus,Ivoclar Vivadent) with

the help of dual cure resin (Multilink Speed,

Ivoclar Vivadent). When the original position

had been reestablished, excess resin was

removed and the area was light- cured for 40

seconds on each surface, making sure that no

displacement of the fragment occurred before

adhesive/resin polymerization was complete.

Contact was relieved in all the protrusive,

lateral movements and teeth were allowed to

have protected occlusion. The occlusion was

carefully checked and adjusted. Splinting was

done for stabilization on the labial surface of

the teeth from canine to canine for two weeks.

Post-operative instructions were given.

Figure 3. Working length Determination

Figure 4. Post-operative radiograph


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Figure 5. Fractured segments attached and

splinting done

DISCUSSION

The reattachment of the crown fragment to

a fractured tooth can be considered as a

most conservative treatment and could be

first choice for crown fractures of anterior

teeth. Tooth reattachment technique

produces good esthetic and functional

result. The traditional conservative

treatment of crown fractures has been

restorations with composite resin and a

dental bonding system. Various materials

such as composite, dual cure resin, light

cured GIC, can be used for reattachment

purpose. The reattached tooth is restored to

its original form, contour and margins and

tends to be more compatible with the

gingiva. The psychological trauma caused

to the individual due to loss of aesthetics

can be managed by this procedure

successfully. Treatment decisions have to

be made case by case for the individual

patient. Important factors for tooth

reattachment are: the degree of the

fragment’s adaptation to the remaining

structure; fragment retention; fracture

location; pattern, periodontal status, pulpal

involvement, maturity of root formation,

biological width invasion and occlusion.

The quality of fit between the segments is

clinically important factor for the

longevity of the reattached crown. In the

present cases reattachment of the fractured

fragment were possible due to

advancements in dentin bonding

technology and fiber post systems. As the

fractured fragments were intact, use of

natural tooth substance clearly eliminated

problems of differential wear of restorative

material, unmatched shades and difficulty

of contour and texture reproduction

associated with other restorative

techniques. The fractured fragment needs

to be preserved in sterile saline or water or

HBSS to prevent colour change due to

dehydration. A lasting dehydration of

tooth’s fragment can cause disturbance of

the esthetics as the longer dehydration of

the fragment is, the greater probability for

not matching the original tooth’s colour

will be. In most cases dehydrated fragment

is lighter than the remained after the

fracture remnant. Return of the natural

colour may need time or may never

occur.5, 6 The techniques described in this

case report is reasonably simple, while

restoring function and esthetics with a very

conservative approach. However, the

professional has to keep in mind that a dry

and clean working field and the proper use


78

of bonding protocol and materials is the

key for achieving success in adhesive

dentistry. Use of prefabricated post

provides the increased retention as well as

the distribution of forces along the root.

Tooth coloured fiber posts have several

advantages. They are more esthetic, can be

bonded to tooth structure, modulus of

elasticity similar to that of dentin, less

chances of fracture, conservative tooth

structure, simple procedure, less chair time

and cost effective7,8. According to the

amount of the restoration, screw posts, cast

posts or dentin pins could be used for

supporting the fragment. Cavaller et al

reported that reattachment of the crown

fragment appeared to have a better long

term prognosis than composite resin

restoration. 9 Assessment of occlusion

after reattachment is essential as occlusal

forces, generated at protrusive movements

of the mandible are extremely destructive

to the relation tooth fragment – bonding

agent.10 The possible afterwards

complications include discoloration of the

attached fragment and fractured reattached

teeth show a high degree of failure to

labial horizontal forces with new trauma.

Regular follow-up is necessary.

CONCLUSION

Reattaching a tooth fragment with newer

adhesive materials may be successfully

used to restore fractured teeth with

adequate strength, but long term follow up

is necessary in order to predict the

durability of the tooth adhesive, fragment

complex and the vitality of the tooth.

REFERENCES

1. Agrawal A, Manwar NU, Chandak

MG. Reattachment of Anterior Teeth

Fragments with Two Different

TreatmentTechniques: Report of Two

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Immediate Reattachment of fractured

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Reattachment of Anterior Teeth

Fragments: A Conservative Approach.

Journal of Esthetics and Restorative

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Attachment –A Conservative Esthetic

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8. Baratieri LN, Monteiro Júnior S, de

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Reattachment of a tooth fragment with

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report. Quintessence Int 1994; 25 (4):

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9. Cavalleri G, German N. Traumatic

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731-743.

1. Dr Radhika Rastogi*, MDS (Conservative

Dentistry & Endodontics), Private Dental

Clinic, Lucknow

2. Dr Akriti Goel MDS, (Conservative

Dentistry & Endodontics), Private Dental

Clinic, Lucknow

3. Dr B. Rajkumar, MDS (Conservative

Dentistry & Endodontics), Professor and

Head, Department of Conservative Dentistry

& Endodontics. Babu Banarasi Das College of

Dental Sciences, Lucknow.

4, Ram Krishna Marg, Faizabad Road,

Lucknow. 226007

*Correspondence to Dr Radhika Rastogi

Email ID: [email protected]

mailto:[email protected]

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